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Individual

SHERESA WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C, LMHCA

Contact information

Practice address
2710 LAKE AVE, FORT WAYNE, IN 46805-5412
(260) 481-2700
(260) 969-8448
Mailing address
16311 PAGE RD, GRABILL, IN 46741-9612
(260) 452-6700

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
88001982A
IN
363A00000X
Physician Assistant
Primary
10000892A
IN
363A00000X
Physician Assistant
5601005190
MI

Other

Enumeration date
10/25/2006
Last updated
01/13/2026
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